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Abstract

Background: The early diastolic mitral inflow and annulus velocities ratio (E/e’) were considered as the parameter to estimate left ventricular (LV) filling pressure. According to the guidelines, this parameter is recommended to use for patients with preserved ejection fraction (EF) (≥50%), but not for patients with depressed EF (<50%). A newly developed three-dimensional speckle-tracking echocardiography can quantify endocardial area change rate (area strain rate) from all 16 LV segments, and could evaluate whole LV endocardial diastolic function. Thus, our objective was to test the hypothesis that early diastolic area change rate (EACR) can express LV relaxation, and E and EACR ratio (E/EACR) can predict LV filling pressures in patients with preserved and depressed EF.

Methods: We studied 102 patients with EF of 39±16% (24 patients with preserved EF and 78 with depressed EF). All patients underwent echocardiography and cardiac catheterization, and echocardiographic examinations were performed within 0.3±6.2 days of catheterization. EACR was measured using three-dimensional global area change rate curve, and LV relaxation time constant (Tau) and pulmonary capillary wedge pressure (PCWP) was measured by cardiac catheterization.

Results: EACR significantly correlated with Tau in all patients (r=-0.50, p<0.001). E/EACR significantly correlated with PCWP in patients with depressed EF as well as in those with preserved EF (r=0.55 and 0.68, both p<0.001), but E/e’ did not. Of 102 patients, 35 (34%) had elevated PCWP (≥12mmHg). E/EACR≥94cm was the best predictor of elevated PCWP with sensitivity 66%, specificity 85%, and area under the curve of 0.76.

Conclusions: EACR can express whole LV relaxation, and E/EACR was a powerful predictor of LV filling pressure regardless of EF and appeared to be a better parameter than E/e’.